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COUNTY OF SAN JOAQUIN Date: 9 / /3 / 06Receivedby <br /> DEPARTMENT OF PUBLIC WORKS CR# <br /> DRIVEWAY AND PAVED FRONTAGES <br /> PERMIT APPLICATION <br /> APPiANT OFFICE USE ONLY <br /> FN4 <br /> ISSUE DATE <br /> SO- ?zZ FEE DUE / <br /> Names DRIVEWAYS: <br /> D Address G GL e <br /> .p�dr� —QUAD <br /> Address, <br /> -Zip CodeYPE <br /> � <br /> Area Code)Telephone OTE <br /> INFORMATION <br /> P arcel Owner's N�/e <br /> Site Address DRIVEWAY WIDTHS <br /> a TYPE QUANTITY <br /> City,State-Zip Code AGRICULTURE @FRONTAGE <br /> 9 �1c�1 COMMERCIAL @ R/W <br /> (Area Code)Telephone USTRIAL —�– <br /> SIDENCE <br /> PAVED FRONTAGE <br /> CONTRACTOR GTH Ft. X WIDTH. Ft. <br /> Name <br /> The undersigned hereby applies for permission to encroach on County Fii way <br /> Address Wight-of-Way oa the S'4 57 side of ✓D/✓ �LANiI/ 1 <br /> approximately f�2 /�eweno� of .4i/�.1 <br /> City,State-Zip Code �n ,by installing '�� <br /> (Area Code)Telephone <br /> Work <br /> will commence on or about for approximately days. <br /> SKETCH(Separate sheet may be submitted) <br /> J <br /> Will this project be self-installed? NO YES Contractor's License <br /> A—Wer Apff.0rivewayFaved frontage <br />